[104-10222-10042.pdf — page 178]
# REQUEST FO 'ORT OF LOYALTY DATA ON AI LANTS AND APPOINTEESSTANDARD FORM 65Promulgated August 4, 1947, byCivil Service Commission(Chapter 12, F.P.M.)THIS FORM TO BE USED ONLY FOR APPLICANTS AND APPOINTEESASHE RECORD CHECKS AND INQUIRIES ARE CONDUCTEDBY CIVIL SERVICE COMMISSION(PART 1-EXECUTIVE ORDER DR35)TO:The following information is furnished for identification purposes on the person named below. Kindly furnish a report on any loyalty information contained in your Lice (The fingerprints of this person are attached.)1. FULL NAME (Initials and   signatures of full name   are not acceptable).(Surname)Zohrung(Given name)Charlotte(Middle of other name)Louise2. DATE OF THIS REQUEST   2/14/513. ALIASES AND NICKNAMES   Sherri4. SPECIAL NUMBERS KNOWN TO REQUESTING AGENCY (FBI number or FBI file number, project number, Army or Navy serial number, seaman's certificate of identification, alien registration number, Social Security number, etc. Specify which)   Social Security No. 069-24-31385. PLACE OF BIRTH   Dayton, Ohio6. DATE OF BIRTH   Jan. 12, 19297. TITLE OF POSITION   Statistical Draftsman SENS   (Division of Geography)8. SEX**MALE****FEMALE**9. MARITAL STATUS**SINGLE**MARRIED10. IF MARRIED, GIVE SPOUSE'S FULL NAME, AND DATE AND PLACE OF BIRTH    None11. DATE OF APPOINTMENT    APPL12. TYPE OF**COMPETITIVE**(in the Civil Service or other legal authority)EXCEPTED(Do not complete in Civil Service)TEMPORARY13. ORGANIZATIONS WITH WHICH AFFILIATED OTHER THAN RELIGIOUS OR POLITICAL ORGANIZATIONS OR THOSE WHICH SHOW RELIGIOUS OR POLITICAL AFFILIATIONS    Delta Gamma Sorority14. DATES AND PLACES OF RESIDENCE FOR THE LAST 10 YEARS| From | To   | Street                   | City           | State          || ---- | ---- | ------------------------ | -------------- | -------------- || 9/41 | 9/46 | San Rae Gardens R. R. 11 | Dayton         | Ohio           || 9/46 | 6/47 | 407 ralnut Ave.          | Syracuse       | N. Y.          || 6/47 | 9/47 | San Rae Gardens          | Dayton         | Ohio           || 9/47 | 4/48 | 901 Kalnut Ave.          | Syracuse       | N. Y.          || 4/48 | 4/49 | 30 Novena Calle Fontento | Guatemala City | Guatemala C.A. || 4/49 | 6/49 | 901 Kalnut Ave.          | Syracuse       | N. Y.          || 6/49 | 9/49 | San Rae Gardens          | Dayton         | Ohio           || 9/49 | 2/50 | 901 Kalnut Ave.          | Syracuse       | N. Y.          || 2/50 | 5/50 | 1101 - 10th St., N. W.   | Washington     | D. C.          |15. DATES, NAMES AND ADDRESSES OF EMPLOYERS FOR THE LAST 10 YEARS| From | To    | Employer                      | Address                                     || ---- | ----- | ----------------------------- | ------------------------------------------- ||      | 6/17  | Unemployed prior to 6/17      |                                             || 6/17 | 9/17  | Friilaire Plant #2            | Dayton 9, Ohio                              || 9/17 | 4/48  | Unemployed                    |                                             || 4/48 | 5/49  | Grants Dept Store (part-time) | Syracuse, N. Y.                             || 5/49 | 6/49  | Unemployed                    |                                             || 6/49 | 9/49  | San Rae Gardens, R. R. 11     | Dayton, Ohio                                || 9/49 | 2/50  | Unemployed                    |                                             || 2/50 | 5/50  | National Peanut Council       | 1111 Dupont Circle Bldg., Washington, D. C. || 5/50 | Pres. | San Rae Gardens               | Dayton, Ohio                                |16. HAS LOYALTY INFORMATION BEEN FURNISHED BY THE AGENCIES INDICATED BELOW| AGENCY WHICH MADE THE LOYALTY HOCKRT | DATE OF REPORT | REMARKS  || ------------------------------------ | -------------- | -------- || none                                 |                | 10-8/201 |17. THIS SPACE RESERVED FOR RETURN REPORT TO AGENCY WHERE DEROGATORY INFORMATION IS DEVELOPED18. NAME AND TITLE OF REPORTING AGENCY    Personnel Officer    Office of the Secretary    Department of the Interior    Washington, D. C.